1336438910 NPI number — MARYNA PETRASHEUSKAYA DDS

Table of content: MARYNA PETRASHEUSKAYA DDS (NPI 1336438910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336438910 NPI number — MARYNA PETRASHEUSKAYA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETRASHEUSKAYA
Provider First Name:
MARYNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336438910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16501-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-454-4530
Provider Business Mailing Address Fax Number:
814-456-2375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 STATE STREET
Provider Second Line Business Practice Location Address:
465
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-456-8548
Provider Business Practice Location Address Fax Number:
814-455-9015
Provider Enumeration Date:
04/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS039227 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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